Differential Diagnosis for Numbness in the Medial Aspect of the Soles of Both Feet
Single Most Likely Diagnosis
- Diabetic Neuropathy: Given the patient's pre-diabetic status, numbness in the feet is a common early symptom of diabetic neuropathy, which affects the peripheral nerves due to high blood sugar levels. The medial aspect of the soles is a typical area affected by this condition.
Other Likely Diagnoses
- Peripheral Artery Disease (PAD): Hypertension is a risk factor for PAD, which can cause reduced blood flow to the feet, leading to numbness. However, PAD typically presents with claudication (pain in the legs or arms during exercise) rather than isolated numbness.
- Vitamin B12 Deficiency: This condition can cause neuropathy, leading to numbness in the feet. It's more common in older adults and can be related to dietary factors or malabsorption.
- Hypertensive Neuropathy: Although less common, long-standing hypertension can lead to neuropathy, affecting the nerves and causing numbness in various parts of the body, including the feet.
Do Not Miss Diagnoses
- Spinal Stenosis or Lumbar Radiculopathy: Compression of the spinal nerves in the lower back can cause numbness in specific areas of the feet, depending on which nerves are affected. This condition requires prompt diagnosis and treatment to prevent permanent nerve damage.
- Tarsal Tunnel Syndrome: Compression of the posterior tibial nerve as it travels through the tarsal tunnel on the inner side of the ankle can cause numbness on the medial aspect of the foot. Early diagnosis is crucial to prevent long-term nerve damage.
Rare Diagnoses
- Amyloidosis: A group of diseases that can cause neuropathy by depositing abnormal proteins (amyloid) in various tissues, including nerves. It's a rare condition but can present with numbness in the feet among other symptoms.
- Charcot-Marie-Tooth Disease: A genetic disorder that affects the peripheral nerves, leading to neuropathy. It typically starts in the feet and can cause numbness, but it's less likely in a 60-year-old presenting for the first time.
- Sjögren's Syndrome: An autoimmune disorder that can cause neuropathy, among other symptoms. It's rare and would typically be accompanied by other systemic symptoms like dry eyes and mouth.